Bilateral Vesicoureteral Reflux in Congenital Nephrotic Syndrome

: Congenital nephrotic syndrome (CNS) is a rare genetic kidney disorder. Different associations between CNS and other organ anomalies have been reported previously. However, urologic abnormalities are not common. This case report can show the association of CNS as a genetic disorder with other abnormalities with a genetic basis. However, the association with urinary abnormalities is rare. We have reported a 25-day-old male newborn, who was referred to our hospital with generalized edema. During the initial evaluation, CNS was diagnosed. The baby, then four months old, was admitted to the hospital with high fever and poor feeding, and a diagnosis of febrile urinary tract infection was made. A voiding cystouretrography was performed that revealed bilateral high-grade vesicoureteral reflux. According to our findings in this case and the genetic basis of CNS and urinary tract anomalies, we recommend the investigation of the urinary tract in CNS patients if indicated.

1435. Urinary Tract Infections Due to Extended-Spectrum Β-Lactamase-Producing Bacteria in Hospitalized Children: Demographics, Risk Factors, Clinical Characteristics, Imaging and Treatment

Background Urinary tract infections (UTIs) are a common cause for hospitalization in children. Inadequate treatment can lead to long-term renal damage. AAP guidelines recommend third-generation cephalosporins as empiric therapy. However, the incidence of community-acquired multiresistant, extended-spectrum β-lactamase (ESBL)-producing pathogens is rising. More research is needed to evaluate risk factors and management of ESBL UTI in children. Methods A case–control retrospective study was conducted at a tertiary care children’s hospital from July 2014 to December 2017. Hospitalized, non-ICU patients aged 0–18 years with UTI and urine culture positive for potentially ESBL-producing organisms were retrieved. Of the 1301 cultures reviewed, 106 cases (UTI+ESBL) were identified and 208 controls (UTI+non-ESBL) were randomly selected. We compared demographics, risk factors, clinical characteristics and treatment between both groups. Results Both groups had similar demographics, except for a higher median age for ESBL patients (3 vs. 0 years). ESBL patients were significantly more likely (P < 0.001) to have recent antibiotic use, history of UTI, urinary tract anomalies or non-renal comorbidities. Both groups had similar clinical presentations and laboratory results. ESBL patients had more VCUGs performed (59.4% vs. 38%), but the prevalence of high-grade VUR was similar in both groups. ESBL patients had longer course of IV antibiotics and length of stay (mean 6 vs. 3 days). Although 59.4% of ESBL patients received inappropriate initial antibiotics based on culture susceptibilities, 77.4% of these patients clinically improved with initial therapy. Conclusion Our results support previous studies demonstrating that prior antibiotic use, history of UTI, urinary tract anomalies or non-renal comorbidities are risk factors for ESBL UTI. When these are encountered, the suspicion for ESBL should be higher and may guide antibiotic therapy pending culture results. Given the similar prevalence of high-grade VUR in both groups, the presence of ESBL UTI alone should not be an indication to obtain a VCUG. Finally, a subgroup of patients with ESBL UTI might be clinically responsive to third-generation cephalosporins, despite in vitro resistance. Disclosures All authors: No reported disclosures.

Obstructing calculus in a single limb of a duplicated ureter: A Recall of the surgical anatomy and the Variable Ureter Anomalies

The ureter is a common site of congenital anomalies which may be associated with a considerable morbidity particularly among young patient. The congenital anomalies of the ureter coexist with multitude of other urinary tract anomalies but it may occur independently. It is more common in females. The complete duplication of the ureter may not produce symptoms which would suggest the presence of malformation. Therefore, such anomaly may not become apparent until later in life. Further, this anomaly might not be recognized prior to the surgery and hence, missing of the stone is highly possible. Herein we present a case of complete ureter duplicate with an obstructive stone located close to VUJ of one limb of the duplicate. A sound knowledge of the surgical anatomy and of the congenital ureter anomalies is essential for correct diagnosis and appropriate management.